Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 04356 | Date 25/03/2019 |
| Token No | SM/19-20/2480 10/05/2019 | Serial | 077 Last Visit: 14/10/2019 |
| Patient Name | Mrs. TINA DAS | Contact No | 9088340686 |
| Address | 501 GT ROAD CHATRA SHITLATALA JAL TANK, BAIDYABTI(M) | Age | 49 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 61 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||